Chapter 4 herbs that purge introduction the concepts downward Interior syndrome 里实证 Stagnation in interior 胃肠积滞 ， Heat, water stock in interior

indications 1 、 acute diseases ： acute pancreatitis, acute biliary duct infection, acute appendicitis, acute intestinal obstruction acute pancreatitis 2 、 infectious diseases ： meningitis, hepatitis Dysentery 3 、 internal diseases ： ascetic fluid, peritonitis 渗出性胸膜 constipation

common effects Puerging action 泻下作用 a. Stimulate the movement of intestine(dahuang) b. Increase water content of the intestine (mangxiao) C. Moisten the stool (Hou Ma Ren)

Induce urination Downward water Anti-microbes Anti-toxin Anti-amoebic dysentery Anti- inflammation Anti-cancer

Dahuang 大黄 Function indication Function indication components Dwonward heat detox in interstine Heat-constipation, bleeding: Ulcer hematemesis Dysentery & acute enteritis, Acute abdominal inflammation (pancreatitis, Peritonitis), Renal failure, Hyperlipidema anthroquinone(main), glycoside, rhein, Chrysophanol, emodin, acatechin, gallic acid

Main pharmacology effects 1. Effects on digestive system (1) purging actions 泻下 Stimulate intestinal movement, however, it can cause constipaton if it is decocted for long time, because of tannic acid

How to purge? rhein Small intestine Large intestine oral main liver Small portion aglycon transfe r E. coli aglycon AglyconAglycon stimulate N in interstine- movement fast gallic acid inhibitNa + -K + -ATP enzyme– water stay in intestine

(2)Protect liver & cholagogize(benefit the gallbladder) 1)It can help the gallbladder contraction, promote Bile secretion 2) It can low serum cholesterol level 3) It can prolong the life of the liver cells & promote regeneration of liver cells

(4) Stimulate pancreatic secretions & restrain the activity of pancreatic juice (5) Anti-peptic ulcer 1)It can control the activity of hydrogen ion in digestion 2) It can prevent stress to ulcer by means of promoting the PGE2; inhibit acid; inhibit

2. Promote renal function (1) It can lower the level of BUN, (2) Diuresis: inhibit Na+-K+-ATP enzyme ， reabsorb Na+.

3. Effects on Circulation system (1) Stop bleeding 1 ） the a-catechin & gallic acid can increase the adherence of platelets. 2 ） It can increase the contraction of blood vessels. (2) Reduce blood stosis 1 ） lower cholesterol & triglycerides 2 ） reduce the blood viscosity

4. Anti-infection/inflammation 1) broad spectrum antibiotic, bacteria & virus, suppressing production of TNF & IL-1. 2) anti-pyretic & sedating actions 3) Reduce CNS fever medium, PGE, & cAMP. 4) Inhibit Na+ － K+ － ATP enzyme acvtivity, reduce ATP production-reduce fever. 5. Anti-cancer Can suppress the RNA & DNA synthesis of cancer cells 6. anti-psychotics 抗精神病

Side effects  It causes pathologic changes in liver & thyroid with hypertrophy of tissue cells.  Common adverse effects: nausea, vomitting, diarrhea & abdominal pain.  Drug interaction: prolonged use of Dahuang may cause loss of potassium, leading to increased toxicity of cardiac glycosides, such as digoxin